Marinol (dronabinol capsules) — Cigna
Nausea and vomiting associated with cancer chemotherapy
Preferred products
- generic dronabinol capsules
Initial criteria
- Approve for 1 year if BOTH of the following are met:
- A) Patient has failed to respond adequately to at least TWO conventional antiemetic treatments;
- Examples of conventional antiemetic treatments include selective serotonin [5-HT3] receptor antagonists (ondansetron, granisetron, Anzemet [dolasetron], Aloxi [palonosetron injection]), Akynzeo (netupitant/palonosetron capsules), Emend (aprepitant capsules), Varubi (rolapitant tablets), metoclopramide, prochlorperazine, dexamethasone, olanzapine.
- B) For Marinol (dronabinol capsules): Patient meets ONE of the following:
- i. Generic dronabinol capsules are requested; OR
- ii. If brand Marinol is being requested, the patient meets BOTH of the following:
- a) Patient has tried generic dronabinol capsules; AND
- b) The Brand product is being requested due to a formulation difference in the inactive ingredient(s) [e.g., difference in dyes, fillers, preservatives] between the Brand and the bioequivalent generic product which, per the prescriber, would result in a significant allergy or serious adverse reaction.
- For Syndros (dronabinol oral solution): Patient meets ONE of the following:
- i. Patient has tried generic dronabinol capsules; OR
- ii. Patient cannot swallow or has difficulty swallowing capsules.
Approval duration
1 year